Node-First Kawasaki Disease Presented with Marked Pancarditis: a Case Report

Kawasaki disease is an acute inflammatory disorder of medium-sized arteries that predominantly affects cardiac coronary arteries and children under the age of 5 years. Cardiac involvement usually happens later than 10 days after the onset of illness. Most of cardiac complications are coronary artery abnormalities (ectasia or aneurysms) and subclinical myocarditis. Clinical myocarditis (symptomatic congestive heart failure), pericarditis, valvulitis and pericardial effusion, as well as pancarditis are rare. This paper reports a 5-year-old boy who had heart failure (ejection fraction 48%) in the acute stage of Kawasaki disease and pericarditis. He was admitted to the hospital following 3 days of continuous fever, bilateral cervical adenopathy and dominant right side neck of torticollis. The results of physical examination after 5 days showed typical Kawasaki disease. Cardiac examination also revealed cardiac murmur and gallop rhythm. In laboratory tests, mild liver dysfunction, hypoproteinemia and hyponatremia were discovered. During hospitalization, troponin levels were positive. The patient was treated with oral high dose aspirin (100 mg/kg/d), two doses of intravenous immunoglobulin (IVIG 2 gm/kg) and three pulses of methylprednisolone. Two weeks later, cardiac evolvements were improved without further complications. The patient exhibited dramatically clinical recovery and was healthy after 8 weeks of follow-up. This case indicates that Lymph-node-first presentation of Kawasaki disease could be examined in children with Kawasaki disease who exhibit symptoms of congestive cardiac failure, pericardial effusion and pericarditis during the acute phase of the disease.